Key result
Network meta-analysis of 45 RCTs identified Yanning, Xiao'er Chiqiao Qingre, Xiao'er Resuqing, Kouyanqing, and Houerhuan Xiaoyan granules as top-ranked for comprehensive improvement in mild HFMD.
Why the study?
Due to conflicting results among increasing randomized controlled trials of herbal granules of heat-clearing and detoxifying, a head-to-head comparison was needed to guide clinical therapy for mild hand, foot, and mouth disease.
Do herbal granules of heat-clearing and detoxifying improve symptoms in children with mild hand, foot, and mouth disease?
Meta-Analysis (n=5,652)
Do herbal granules of heat-clearing and detoxifying improve symptoms in children with mild hand, foot, and mouth disease?
In a network meta-analysis of children with mild HFMD, several herbal granules showed potential for improving symptoms, though results are limited by RCT quality.
Certain herbal granules may aid mild pediatric HFMD; extends RCT evidence but leaves open due to quality limitations.
Background: Regarding ethical considerations of randomized controlled trials (RCTs) in children, limited evidence for mild hand, foot, and mouth disease (HFMD) is available. Recently, with the increasing but result-conflicting RCTs published around herbal granules of heat-clearing and detoxifying (HGs-HD), a head-to-head comparison is urgently needed to choose a suitable therapy for clinical practice. Materials and Methods: This study was conducted according to the preferred reporting items for systematic review and meta-analysis (PRISMA) extension statement for network meta-analysis (NMA). Eight databases (Medline, Embase, and so on) and two trial registry platforms (https://www.clinicaltrials.gov and https://www.chictr.org.cn) were searched from inception to May 26, 2021. The NMA was performed using a random-effect model. The treatment hierarchy was summarized and reported as the surface under the cumulative ranking curve (SUCRA) probability values. The rankings of each HGs-HD at primary outcomes were estimated by the inverse probability weighting (IPW) approach and averaged, which presents the comprehensive improvement effect. Results: Forty-five RCTs involving 18 interventions were included that studied 5,652 children with mild HFMD. The best performance probability for improving symptoms were respectively presented in terms of fever (Xiao'er Resuqing granules, XRGs, 94.9%), rash (Xiao'er Jinqiao granules, 83.9%), hospitalization (Xiao'er Chiqiao Qingre granules, XCQGs, 92.7%), vesicles (Jinlianhua granules, 91.0%), appetite (Xiao'er Chiqiao Qingre granules, XCQGs, 86.7%), and ulcers (Kouyanqing granules, KouGs, 88.8%). Furthermore, the top 5 rankings for comprehensive improvement effect were Yanning granules (YNGs, 2.256), XCQGs (2.858), XRGs (3.270), KouGs (7.223), and Houerhuan Xiaoyan granules (HXGs, 7.597). Conclusions: This is the first NMA of HGs-HD head-to-head comparisons for children with mild HFMD. Of those, YNGs, XCQGs, XRGs, KouGs, and HXGs could be recommended as potential choices for clinical practice. Of course, the results should be interpreted with caution due to the limited high-quality RCTs.
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Sheng et al. (2022) conducted a meta-analysis in mild hand, foot, and mouth disease (HFMD) (n=5,652). Herbal granules of heat-clearing and detoxifying (HGs-HD) vs. Other herbal granules (head-to-head) was evaluated on symptom improvement (fever, rash, hospitalization, vesicles, appetite, ulcers) and comprehensive improvement effect. Network meta-analysis of 45 RCTs identified Yanning, Xiao'er Chiqiao Qingre, Xiao'er Resuqing, Kouyanqing, and Houerhuan Xiaoyan granules as top-ranked for comprehensive improvement in mild HFMD.
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